Provider Demographics
NPI:1134131352
Name:CORAM HEALTHCARE/CAROLINA HOME THERAPEUTICS
Entity Type:Organization
Organization Name:CORAM HEALTHCARE/CAROLINA HOME THERAPEUTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:WEINERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:401-765-1500
Mailing Address - Street 1:PO BOX 809160
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60680-9160
Mailing Address - Country:US
Mailing Address - Phone:480-765-5043
Mailing Address - Fax:401-733-2011
Practice Address - Street 1:720 GRACERN RD
Practice Address - Street 2:SUITE 123
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7655
Practice Address - Country:US
Practice Address - Phone:803-731-5076
Practice Address - Fax:803-731-4979
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CORAM HEALTHCARE/CAROLINA HOME THERAPEUTICS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-13
Last Update Date:2024-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251E00000X, 251F00000X, 261QI0500X
SC50-004889332BP3500X, 333600000X, 3336C0003X, 3336H0001X, 3336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
No251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4219362OtherNCPDP
SC10-04889OtherRX LICENSE
BC1766217OtherDEA
SC0334970001Medicare NSC